NPIMap

Organization Active NPI

Wellstar Medical Group, LLC

Doing business as WellStar Internal Medicine (White Circle)

  • Internal Medicine Physician
  • Marietta, GA
National Provider Identifier
1205262292
Registry record updated Nov 18, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
WELLSTAR MEDICAL GROUP, LLC
Doing business as
WellStar Internal Medicine (White Circle)
Practice address
1810 White Cir
Suite 105
Marietta, GA 30066-5835
Phone
(678) 797-6820
Fax
(770) 424-8787
NPI assigned
Sep 23, 2013
Last updated
Nov 18, 2013By the provider in NPPES
Organization subpart
Yes
Parent organization
WELLSTAR MEDICAL GROUP, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 18, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Nicole Ashe
Title
Executive Director of Finance
Phone
(470) 644-0095

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X GA Primary

Addresses

Primary practice location

1810 White Cir
Suite 105
Marietta, GA 30066-5835

Mailing address

1810 White Cir
Suite 105
Marietta, GA 30066-5835
Phone (678) 797-6820

Other names 1

  • WellStar Internal Medicine (White Circle) Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110127000374 GA Part B Supplier - Clinic/Group Practice 6709065402 Receives reassigned benefits from 4,219 practitioners
This NPI is an additional NPI on the enrollment

National Provider Directory

National Provider Directory
Tax ID family
Pulmonary Wellstar125 organizations share this tax ID, including this one
Part of
Pulmonary Wellstar

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Locations

1810 White Cir
Ste 105
Marietta, GA 30066
Phone (678) 797-6820

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1379894400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1384732800000",
    "number": "1205262292",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1810 WHITE CIR",
            "address_2": "SUITE 105",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300665835",
            "telephone_number": "678-797-6820",
            "fax_number": "770-424-8787"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1810 WHITE CIR",
            "address_2": "SUITE 105",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300665835",
            "telephone_number": "678-797-6820",
            "fax_number": "770-424-8787"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WELLSTAR MEDICAL GROUP, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WELLSTAR MEDICAL GROUP, LLC",
        "enumeration_date": "2013-09-23",
        "last_updated": "2013-11-18",
        "status": "A",
        "authorized_official_last_name": "ASHE",
        "authorized_official_first_name": "NICOLE",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR OF FINANCE",
        "authorized_official_telephone_number": "470-644-0095"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "GA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "WellStar Internal Medicine (White Circle)",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Marietta, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.